Diabetic retinopathy and cognitive decline in older people with Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study

Jie Ding, Mark W. J. Strachan, Rebecca M. Reynolds, Brian M. Frier, Ian J. Deary, F. Fowkes R. Gerald, Amanda J Lee, Janet McKnight, Patricia Halpin, Ken Swa, Jackie F. Price, Edinburgh Type 2 Diabetes Study (ET2DS) Investigators

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE Cerebral microvascular disease associated with type 2 diabetes may exacerbate the effects of aging on cognitive function. A considerable homology exists between the retinal and cerebral microcirculations; a hypothesized association between diabetic retinopathy (DR) and cognitive decline was examined in older people with type 2 diabetes.

RESEARCH DESIGN AND METHODS In the population-based Edinburgh Type 2 Diabetes Study, 1,046 men and women aged 60–75 years with type 2 diabetes underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. A general cognitive ability score (g) was generated by principal components analysis. The Mill-Hill Vocabulary Scale was used to estimate premorbid cognitive ability. DR was graded using a modification of the Early Treatment of Diabetic Retinopathy Scale.

RESULTS After age and sex adjustment, a significant relationship was observed with increasing severity of DR (none, mild, and moderate to severe) for most cognitive measures. Participants with moderate-to-severe retinopathy had the worst g and the worst performances on the individual tests. There was a significant interaction between sex and retinopathy for g. In male subjects, the associations of retinopathy with g (and with tests of verbal fluency, mental flexibility, and processing speed but not memory and nonverbal reasoning) persisted (P < 0.05) when further adjusted for vocabulary (to estimate lifetime cognitive decline), depression, sociodemographic characteristics, cardiovascular risk factors, and macrovascular disease.

CONCLUSIONS DR was independently associated with estimated lifetime cognitive decline in older men with type 2 diabetes, supporting the hypothesis that cerebral microvascular disease may contribute to their observed accelerated age-related cognitive decline. A sex interaction with stronger findings in men requires further confirmation.
Original languageEnglish
Pages (from-to)2883-2889
Number of pages7
JournalDiabetes
Volume59
Issue number11
DOIs
Publication statusPublished - Nov 2010

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Diabetic Retinopathy
Type 2 Diabetes Mellitus
Aptitude
Vocabulary
Cognition
Social Adjustment
Photography
Microcirculation
Principal Component Analysis
Cognitive Dysfunction
Depression
Population

Keywords

  • aged
  • cerebrovascular circulation
  • cognition
  • cognition disorders
  • cohort studies
  • cross-sectional studies
  • diabetes mellitus, type 2
  • diabetic angiopathies
  • diabetic retinopathy
  • educational status
  • female
  • health surveys
  • humans
  • hypoglycemic agents
  • insulin
  • male
  • memory
  • middle aged
  • Scotland
  • sex characteristics
  • vision, binocular
  • visual acuity

Cite this

Ding, J., Strachan, M. W. J., Reynolds, R. M., Frier, B. M., Deary, I. J., Gerald, F. F. R., ... Edinburgh Type 2 Diabetes Study (ET2DS) Investigators (2010). Diabetic retinopathy and cognitive decline in older people with Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes, 59(11), 2883-2889. https://doi.org/10.2337/db10-0752

Diabetic retinopathy and cognitive decline in older people with Type 2 Diabetes : the Edinburgh Type 2 Diabetes Study. / Ding, Jie; Strachan, Mark W. J.; Reynolds, Rebecca M.; Frier, Brian M.; Deary, Ian J.; Gerald, F. Fowkes R.; Lee, Amanda J; McKnight, Janet; Halpin, Patricia; Swa, Ken; Price, Jackie F.; Edinburgh Type 2 Diabetes Study (ET2DS) Investigators.

In: Diabetes, Vol. 59, No. 11, 11.2010, p. 2883-2889.

Research output: Contribution to journalArticle

Ding, J, Strachan, MWJ, Reynolds, RM, Frier, BM, Deary, IJ, Gerald, FFR, Lee, AJ, McKnight, J, Halpin, P, Swa, K, Price, JF & Edinburgh Type 2 Diabetes Study (ET2DS) Investigators 2010, 'Diabetic retinopathy and cognitive decline in older people with Type 2 Diabetes: the Edinburgh Type 2 Diabetes Study' Diabetes, vol. 59, no. 11, pp. 2883-2889. https://doi.org/10.2337/db10-0752
Ding, Jie ; Strachan, Mark W. J. ; Reynolds, Rebecca M. ; Frier, Brian M. ; Deary, Ian J. ; Gerald, F. Fowkes R. ; Lee, Amanda J ; McKnight, Janet ; Halpin, Patricia ; Swa, Ken ; Price, Jackie F. ; Edinburgh Type 2 Diabetes Study (ET2DS) Investigators. / Diabetic retinopathy and cognitive decline in older people with Type 2 Diabetes : the Edinburgh Type 2 Diabetes Study. In: Diabetes. 2010 ; Vol. 59, No. 11. pp. 2883-2889.
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AU - Frier, Brian M.

AU - Deary, Ian J.

AU - Gerald, F. Fowkes R.

AU - Lee, Amanda J

AU - McKnight, Janet

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AU - Edinburgh Type 2 Diabetes Study (ET2DS) Investigators

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N2 - OBJECTIVE Cerebral microvascular disease associated with type 2 diabetes may exacerbate the effects of aging on cognitive function. A considerable homology exists between the retinal and cerebral microcirculations; a hypothesized association between diabetic retinopathy (DR) and cognitive decline was examined in older people with type 2 diabetes. RESEARCH DESIGN AND METHODS In the population-based Edinburgh Type 2 Diabetes Study, 1,046 men and women aged 60–75 years with type 2 diabetes underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. A general cognitive ability score (g) was generated by principal components analysis. The Mill-Hill Vocabulary Scale was used to estimate premorbid cognitive ability. DR was graded using a modification of the Early Treatment of Diabetic Retinopathy Scale. RESULTS After age and sex adjustment, a significant relationship was observed with increasing severity of DR (none, mild, and moderate to severe) for most cognitive measures. Participants with moderate-to-severe retinopathy had the worst g and the worst performances on the individual tests. There was a significant interaction between sex and retinopathy for g. In male subjects, the associations of retinopathy with g (and with tests of verbal fluency, mental flexibility, and processing speed but not memory and nonverbal reasoning) persisted (P < 0.05) when further adjusted for vocabulary (to estimate lifetime cognitive decline), depression, sociodemographic characteristics, cardiovascular risk factors, and macrovascular disease. CONCLUSIONS DR was independently associated with estimated lifetime cognitive decline in older men with type 2 diabetes, supporting the hypothesis that cerebral microvascular disease may contribute to their observed accelerated age-related cognitive decline. A sex interaction with stronger findings in men requires further confirmation.

AB - OBJECTIVE Cerebral microvascular disease associated with type 2 diabetes may exacerbate the effects of aging on cognitive function. A considerable homology exists between the retinal and cerebral microcirculations; a hypothesized association between diabetic retinopathy (DR) and cognitive decline was examined in older people with type 2 diabetes. RESEARCH DESIGN AND METHODS In the population-based Edinburgh Type 2 Diabetes Study, 1,046 men and women aged 60–75 years with type 2 diabetes underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. A general cognitive ability score (g) was generated by principal components analysis. The Mill-Hill Vocabulary Scale was used to estimate premorbid cognitive ability. DR was graded using a modification of the Early Treatment of Diabetic Retinopathy Scale. RESULTS After age and sex adjustment, a significant relationship was observed with increasing severity of DR (none, mild, and moderate to severe) for most cognitive measures. Participants with moderate-to-severe retinopathy had the worst g and the worst performances on the individual tests. There was a significant interaction between sex and retinopathy for g. In male subjects, the associations of retinopathy with g (and with tests of verbal fluency, mental flexibility, and processing speed but not memory and nonverbal reasoning) persisted (P < 0.05) when further adjusted for vocabulary (to estimate lifetime cognitive decline), depression, sociodemographic characteristics, cardiovascular risk factors, and macrovascular disease. CONCLUSIONS DR was independently associated with estimated lifetime cognitive decline in older men with type 2 diabetes, supporting the hypothesis that cerebral microvascular disease may contribute to their observed accelerated age-related cognitive decline. A sex interaction with stronger findings in men requires further confirmation.

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KW - educational status

KW - female

KW - health surveys

KW - humans

KW - hypoglycemic agents

KW - insulin

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KW - memory

KW - middle aged

KW - Scotland

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KW - vision, binocular

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